You can certainly keep a 'competitive' environment which is regulated with incentives. And I do agree healthcare needs this, and shouldn't live purely by the free market.
This is the model many rich country healthcare runs on, and provides measurably better outcomes for less expenditure than the US.
I think that worrying about removing the profit motive entirely misses that fact that not only is the profit motive not the only motive for doing things, but oftentimes not even the determinate factor.
The more likely explanation for Castro seeking treatment in Spain is that Cuba is a relatively small country of only 11 million, and it should be expected that they're not at the very forefront of the world on every area of medical expertise.
However, in a single payer or similar systems, if a drug company decides to hike the price, the state (or institution) can swallow the cost and continue medical services to citizens until the situation is resolved (either by legislation or court cases). Since the state (or institution) is not a for-profit it doesn't matter as much if they sink a lot of cost as long as everyone can get their medical treatment.
IIRC, the research typically comes from state-funded academics, and the development comes from the manufacturers.
And big pharma companies don't do early stage research. Small companies do. Most of those are in US
I am completely on the side of having government agencies developing cures and licensing out to companies then. This would avoid the perverse incentive of the OP. It also would stop the pervasive argument that patents are necessary to get new pharmaceuticals developed (I don't believe in patents benefit to society).
I would say in some cases that is a good thing. https://en.wikipedia.org/wiki/Thalidomide
https://en.wikipedia.org/wiki/Medical_research#Privately_(in...
Private R&D is around 60% - however a large part of that is making minor changes to existing molecules in order to obtain fresh patents.The bigger, riskier research is done by the NIH and other publicly funded bodies. See
https://marianamazzucato.com/entrepreneurial-state/
Also - the quality of privately funded research is much worse, with non-reporting of negative results, data dredging and other dodgy activities being routine - see
Goldacre's book (he also has a blog) is well worth reading - describing _many_ ways in which drug companies can cheat.
Novartis? AstraZenica? Gsk? Bayer? Siemens? Hitachi? Philips? Olympus?
this works quite very much the other way as well..
well I'm living in Germany and I agree with that it is cheaper, but "better outcomes"? I do not think so.
I mean in Germany treating Diabetes means taking Insulin for a life long. However newer studies, actually found out that a treatment where the patient should be dieting and starts to do more sport can actually reduce the needed insulin dose or patients can even completely dismiss insulin or are cured from it completely in rare cases. (not a lot of doctors would actually help the patient or even tell them that this would be beneficial to them, hell not even the public health care sector cares)
However the thing is if you can sell Insulin for a life long to somebody who will probably die earlier you make a profit. On multiple fronts. Treating it means that once the person is cured, he will probably live longer, will have less problems and will probably cost the overall system less (but that's not something that should happen).
So basically in "richer" countries the system is equal to the US, it's just more hidden. care system and government are systems that benefit from each other if patients take treatments over a long time and probably have a reduced life-time. i.e. treatment > healing, at least from a business perspective.
That being said, the only source I can find for your claim is a throwaway sentence in an op-ed on Forbes (https://www.forbes.com/sites/paulroderickgregory/2012/07/01/...).
I found some more realistic (and sourced) statistics here: http://blogs.sciencemag.org/pipeline/archives/2010/11/09/whe...
That has the U.S. at 47% of drugs developed. Keep in mind those are based on drugs approved by the FDA, so it skews towards the U.S., and especially away from countries like Japan. Adjusted for population (I'm not entirely sure this is fair), that puts us neck-and-neck with the U.K., behind Israel, and far behind Switzerland.
The US has the best outcomes in the world if you have money. Which is why rich people from all over the world come here for treatment. We just have lower average outcomes because of access disparities.
The US has average healthcare when money is no object. The weathty often seak treatment outside the US and occasionally wealthy people come to the US on a case by case basis.
The core problem is treatments entail risk, so doing more eventually results in worse outcomes. Further the incentives are around doing more, putting the healthcare system in opposition to heathy patients.
That's why universal healthcare is the better solution for everyone.
Why?
Schools are not for-profit institutions (well, not everywhere). Police don't make a profit. Nor does the fire brigade. Or the military, for that matter.
Are all of these disasters waiting to happen?
As further examples of state level institutions we could also look at coast guard and customs service. And, of course, the tax officials (what ever their local name happens to be in various countries).
A modern nation state is full of public institutions with dedicated personnel to carry the institutions mission.
Public institutions work just fine around the world in various countries, performing a multitude of missions. That's not to say they are immune to various pathologies, but that applies to all organizations, public, private, for-profit or non-profit. Public institutions work fine when they are fulfilling a legally defined obligation under a democratically chosen government.
The thing everyone wants to avoid is pathological cronyism. The key to this is to make sure the political power pool has churn - so there is no predictable kingpin with executive power around whom the power and corruption accumulates. Which, democratically chosen governments provide (with varying capacity, but even two parties is probably enough).
I agree, no one wants to funnel tax payer money just to amass state power. But some things that improve life really cannot in any obvious way be guided by profit mechanism, and some things are just too capital intensive to be able to do on a small scale. The obvious place to look for capital for large scale projects that add value to the general public is the state.
Note: although monarchs do exist as mostly figure heads, modern monarch seldom have executive power. Compare this to some countries with dictators or monarch with actual executive power.
Let's make it a bit more ridiculous and extreme. Would it be a good idea to privatize US nukes? What would profit incentive provide there?
Remember, we are discussing the claim "creating public institutions without a profit incentive is a disaster waiting to happen".
[citation needed] My understanding is that they are more expensive than uniformed soldiers.
> You can certainly keep a 'competitive' environment which is regulated with incentives.
This is my preferred approach as well. It's worst weakness is the potential for regulatory capture. I tend to believe that should be addressed by not giving corporations as much power as they currently enjoy in the US: enforcing constraints on participation in politics and requiring transparency, disconnecting health insurance from employment status, enabling clawback of executive bonuses, etc.
This in my opinion is a false dichotomy. The government can be owned/operated by coorporations or by the people or can be an entity in itself.
What I feel is missed by people leaning towards the idea of competition is that it is not a sustainable model under the current framework of ideas. If you optimise a society purely based on profitability, competition is the enemy, since it hinders individual businesses from maximising their profits. Hence the massive business consolidation we have seen in the last decade across the globe.
If you want competition because you want different ideas to be tested, then we need to explain what we want entities to compete for. Focusing on optimising one variable only, i.e. profit, will not work. We need new ideas.
We seem to have no problem with throwing $700 billion per year on the military and nobody is pressuring them to make a profit. Is that a disaster? No? "But that's different!" It's only "different" because that's what we've been led to believe.
We give the government the leeway we do, because it is the best way to provide for the common defense of the nation. NOT because ONLY the State should have violence open to it as an option.
Anyway... Back to healthcare... The type of structure that made the military industrial complex problematic was specifically that the industrial part was doing everything they could via lobbying/bribery to maximize profit. A shift to a model where we attempt to minimize waste, and maximize effective treatment/cures turns the quality equation on it's head. You still run into the issue where riskier grants that 'may work' are going to have a harder case to make in order to be issued, but I think that once one gets away from trying to build industrial supply chains predominantly for treatments that don't result in cure, you would start to see materials and expertise to get industrial supply chains built period may become more easily accessible if not perhaps become much cheaper.
The 2nd Amendment is completely compatible with the philosophical concept of monopoly on legitimate violence as articulated by Weber.
I think that the whole point of 2nd Amendment to US Constitution was to prevent government monopoly on violence. The possibility of citizens making successful military rebellion against the state was supposed to keep the government in check.
A monopoly on violence in what context? The planet? That doesn't seem to be necessary for most countries. Within the country itself? That's the job of local law enforcement.
https://en.wikipedia.org/wiki/Monopoly_on_violence#Max_Weber...
All the critiques on this thread about competing authorities such as local law enforcement, the second amendment, and so on, none of them invalidate the idea of legitimate use of force defining the state. Weber accounts for all those points.
The closest thing we have to an actual marketplace among authorities wielding violence is the competition between jurisdictions (one municipal police department against the one the next town over, the state police in one US state vs another US state) -- but that's not the same as a commercial marketplace.
The only critique I think is relevant is the idea of mercenaries, a.k.a. private military contractors. But there again, those mercenaries are part of the military-industrial complex, which is an extremely stunted marketplace as it's largely a government monopsony.
We don't use economic competition to determine who holds authority on the legitimate use of violence. As a consequence, we don't get the full benefit of marketplace competition in maximizing the efficiency of our armed forces -- but we also don't have perpetual civil war.
That is not the case in the USA, where the absence of such a monopoly is written into the federal constitution.
I don't think you know what the "[state] monopoly on violence" means. It does not mean all people authorized to use force are directly on the government payroll.
To expect results or effects is not the same as making profits.
We talk about AI optimized to create paper clips accidentally running amok and turning the world into paper clips. Why isn't profit a similar problem? Government agencies are just AI running on meat. Give them success parameters different than raw profits.
Honestly, why can't we see this as just a variant of the instrumental convergence problem?
Aren't most public institutions non-profits? Don't many of these work well? What makes you think that a (truly) democratically run enterprise wouldn't satisfy the needs of its constituents?
Political hobbling and fuckery related to post office operations done to marginalize otherwise exemplary performance aside, the model has merit.